{"title":"Erratum.","authors":"","doi":"10.1353/pbm.2023.0012","DOIUrl":"10.1353/pbm.2023.0012","url":null,"abstract":"","PeriodicalId":54627,"journal":{"name":"Perspectives in Biology and Medicine","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140859145","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Over recent decades, progress in bioscience research has been remarkable, but alongside the many transformative advances is a growing concern that a surprisingly high fraction of published research cannot be reproduced by the scientific community. Though experimental and interpretive errors are unavoidable features of the scientific process, recent evidence suggests that irreproducibility is a serious issue requiring analysis, understanding, and remediation. This article reviews the meaning of research reproducibility, examines ongoing efforts to estimate its prevalence, and considers the factors that contribute to it. Two recent case studies illustrate the disparate responses that researchers may take when facing serious claims that a high-profile research finding is irreproducible and may be false. Finally, the article examines potential interventions to counter the current level of irreproducibility, aimed at increasing the efficiency and impact of society’s substantial and critically important investment in bioscience research.
{"title":"The Problem of Irreproducible Bioscience Research","authors":"Jeffrey Flier","doi":"10.1353/pbm.0.0031","DOIUrl":"https://doi.org/10.1353/pbm.0.0031","url":null,"abstract":"Over recent decades, progress in bioscience research has been remarkable, but alongside the many transformative advances is a growing concern that a surprisingly high fraction of published research cannot be reproduced by the scientific community. Though experimental and interpretive errors are unavoidable features of the scientific process, recent evidence suggests that irreproducibility is a serious issue requiring analysis, understanding, and remediation. This article reviews the meaning of research reproducibility, examines ongoing efforts to estimate its prevalence, and considers the factors that contribute to it. Two recent case studies illustrate the disparate responses that researchers may take when facing serious claims that a high-profile research finding is irreproducible and may be false. Finally, the article examines potential interventions to counter the current level of irreproducibility, aimed at increasing the efficiency and impact of society’s substantial and critically important investment in bioscience research.","PeriodicalId":54627,"journal":{"name":"Perspectives in Biology and Medicine","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2022-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45271113","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
ABSTRACT:Severe Acute Respiratory Syndrome (SARS) was the first pandemic of the 21st century, and Canada was the only Western nation to experience an outbreak. The effects of the outbreak on Canadian society provide a window to understanding responses to future pandemics. Over the short run, SARS had a major effect on the Canadian economy: adverse effects were experienced by health-care workers, who were at greatest risk of contracting the disease; by workers in the hospitality industry, who lost income as tourism and travel ground to a halt; and by the Chinese-Canadian community, who experienced discrimination because of the Chinese origins of SARS. However, over the long term there were few consequences of the outbreak in Canada, whether in the social, economic, or political domains. The principal effects were improvements in the Canadian public health system, many of which were rolled back after a decade without a major epidemic.
{"title":"When Corona Came to Canada: The 2003 SARS Outbreak and Its Aftermath","authors":"M. Gillick","doi":"10.1353/pbm.2022.0001","DOIUrl":"https://doi.org/10.1353/pbm.2022.0001","url":null,"abstract":"ABSTRACT:Severe Acute Respiratory Syndrome (SARS) was the first pandemic of the 21st century, and Canada was the only Western nation to experience an outbreak. The effects of the outbreak on Canadian society provide a window to understanding responses to future pandemics. Over the short run, SARS had a major effect on the Canadian economy: adverse effects were experienced by health-care workers, who were at greatest risk of contracting the disease; by workers in the hospitality industry, who lost income as tourism and travel ground to a halt; and by the Chinese-Canadian community, who experienced discrimination because of the Chinese origins of SARS. However, over the long term there were few consequences of the outbreak in Canada, whether in the social, economic, or political domains. The principal effects were improvements in the Canadian public health system, many of which were rolled back after a decade without a major epidemic.","PeriodicalId":54627,"journal":{"name":"Perspectives in Biology and Medicine","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2022-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43914404","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
ABSTRACT:Assuming robots of the future will be far more advanced than their present-day forebears, it is not premature to ask what they will have to be like in order to have moral status. This article first examines criteria for moral status, criticizing several models before briefly defending an interest-based account. It next investigates the epistemological challenge of applying criteria for moral status to robots, before eliciting implications with attention to basic moral status, rights, and respect for autonomy. The article concludes with reflections on species-based prejudice and an acute practical dilemma that will confront robotics.
{"title":"Robots with Moral Status?","authors":"D. DeGrazia","doi":"10.1353/pbm.2022.0004","DOIUrl":"https://doi.org/10.1353/pbm.2022.0004","url":null,"abstract":"ABSTRACT:Assuming robots of the future will be far more advanced than their present-day forebears, it is not premature to ask what they will have to be like in order to have moral status. This article first examines criteria for moral status, criticizing several models before briefly defending an interest-based account. It next investigates the epistemological challenge of applying criteria for moral status to robots, before eliciting implications with attention to basic moral status, rights, and respect for autonomy. The article concludes with reflections on species-based prejudice and an acute practical dilemma that will confront robotics.","PeriodicalId":54627,"journal":{"name":"Perspectives in Biology and Medicine","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2022-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44601696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
ABSTRACT:Traditionally, the understanding of biological mechanisms has played a central role in clinical reasoning. With the rise of the evidence-based paradigm, however, this role has come under scrutiny. On the one hand, clinical guidelines now place less emphasis on the evidence of pathophysiological mechanisms, a shift motivated by the unreliability of our understanding of complex biological mechanisms. On the other hand, some scholars defend evidence of mechanisms as crucial for clinical practice. This article assesses the relevance of evidence of biological mechanisms in two types of clinical predictions: predictions about the efficacy and about the safety of a certain intervention for a particular patient. For each type of prediction, the article analyzes the two roles that evidence of mechanisms might have—confirming and disconfirming—depending on whether the evidence supports that certain epidemiological results apply to the single patient. The analysis shows that the “unreliability because of incompleteness” argument against the emphasis on mechanistic clinical thinking only applies to some of the considered cases. The article concludes by offering a model for a more granular view of the role that evidence of mechanisms should play in clinical practice.
{"title":"Evidence of Biological Mechanisms and Health Predictions: An Insight into Clinical Reasoning","authors":"Saúl Pérez-González, E. Rocca","doi":"10.1353/pbm.2022.0005","DOIUrl":"https://doi.org/10.1353/pbm.2022.0005","url":null,"abstract":"ABSTRACT:Traditionally, the understanding of biological mechanisms has played a central role in clinical reasoning. With the rise of the evidence-based paradigm, however, this role has come under scrutiny. On the one hand, clinical guidelines now place less emphasis on the evidence of pathophysiological mechanisms, a shift motivated by the unreliability of our understanding of complex biological mechanisms. On the other hand, some scholars defend evidence of mechanisms as crucial for clinical practice. This article assesses the relevance of evidence of biological mechanisms in two types of clinical predictions: predictions about the efficacy and about the safety of a certain intervention for a particular patient. For each type of prediction, the article analyzes the two roles that evidence of mechanisms might have—confirming and disconfirming—depending on whether the evidence supports that certain epidemiological results apply to the single patient. The analysis shows that the “unreliability because of incompleteness” argument against the emphasis on mechanistic clinical thinking only applies to some of the considered cases. The article concludes by offering a model for a more granular view of the role that evidence of mechanisms should play in clinical practice.","PeriodicalId":54627,"journal":{"name":"Perspectives in Biology and Medicine","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2022-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48796104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
ABSTRACT:Since psychoneuroimmunology’s (PNI) inception four decades ago, so-called “mind-body” approaches relying on or inspired by PNI have offered the promise of healing various ailments based on the age-old but metaphysically ambiguous principle that the mind can heal the body. How this principle is operationalized not only reveals limitations of PNI-based mind-body therapies but offers a test kit of possibilities for exploring the conceptual foundations of PNI. This article presents an integrative analysis of the role of consciousness-related phenomena (such as willful intentions, thoughts, beliefs) in their causal efficacy, examining their relationships with placebo effects and the boundaries of immune homeostatic control, as well as their therapeutic prospects. Focusing on mindfulness, the article notes how understanding the mechanisms of mindfulness, specifically those mechanisms related to consciousness and placebo effects, can lend insight into how it can validly be evaluated for effectiveness. While taking care not to overstate the role of consciousness in the control of immune homeostatic functions, this article places consciousness center stage to evaluate how mindfulness might be harnessed to modulate the immune system in a clinically relevant manner.
{"title":"Consciousness, Placebo Effects, and the Therapeutic Allure of Psychoneuroimmunology","authors":"S. Tresker","doi":"10.1353/pbm.2022.0000","DOIUrl":"https://doi.org/10.1353/pbm.2022.0000","url":null,"abstract":"ABSTRACT:Since psychoneuroimmunology’s (PNI) inception four decades ago, so-called “mind-body” approaches relying on or inspired by PNI have offered the promise of healing various ailments based on the age-old but metaphysically ambiguous principle that the mind can heal the body. How this principle is operationalized not only reveals limitations of PNI-based mind-body therapies but offers a test kit of possibilities for exploring the conceptual foundations of PNI. This article presents an integrative analysis of the role of consciousness-related phenomena (such as willful intentions, thoughts, beliefs) in their causal efficacy, examining their relationships with placebo effects and the boundaries of immune homeostatic control, as well as their therapeutic prospects. Focusing on mindfulness, the article notes how understanding the mechanisms of mindfulness, specifically those mechanisms related to consciousness and placebo effects, can lend insight into how it can validly be evaluated for effectiveness. While taking care not to overstate the role of consciousness in the control of immune homeostatic functions, this article places consciousness center stage to evaluate how mindfulness might be harnessed to modulate the immune system in a clinically relevant manner.","PeriodicalId":54627,"journal":{"name":"Perspectives in Biology and Medicine","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2022-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42178663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
ABSTRACT:Despite the impact of vaccination on the control and prevention of many infectious diseases, vaccine opposition and hesitancy remain significant barriers to fully protecting individuals and communities against serious disease. The primary response to the problem of vaccine hesitancy includes persuasion and some degree of compulsion, usually in the form of vaccine mandates. Persuasion, if it can be successfully leveraged to provide sufficient control of disease spread, is the ethically preferred approach. Yet persuasion has proven less than adequate, leading to increasing calls for vaccination mandates and the elimination of nonmedical exemptions to those mandates. Four scholars have recently examined the underlying causes of vaccine hesitancy in the interest of improving rhetoric surrounding vaccination. This article reviews those books and offers suggestions for optimizing the strategy of persuasion in the interest of reducing the need for compulsion.
{"title":"Rhetoric, Persuasion, Compulsion, and the Stubborn Problem of Vaccine Hesitancy","authors":"D. Diekema","doi":"10.1353/pbm.2022.0006","DOIUrl":"https://doi.org/10.1353/pbm.2022.0006","url":null,"abstract":"ABSTRACT:Despite the impact of vaccination on the control and prevention of many infectious diseases, vaccine opposition and hesitancy remain significant barriers to fully protecting individuals and communities against serious disease. The primary response to the problem of vaccine hesitancy includes persuasion and some degree of compulsion, usually in the form of vaccine mandates. Persuasion, if it can be successfully leveraged to provide sufficient control of disease spread, is the ethically preferred approach. Yet persuasion has proven less than adequate, leading to increasing calls for vaccination mandates and the elimination of nonmedical exemptions to those mandates. Four scholars have recently examined the underlying causes of vaccine hesitancy in the interest of improving rhetoric surrounding vaccination. This article reviews those books and offers suggestions for optimizing the strategy of persuasion in the interest of reducing the need for compulsion.","PeriodicalId":54627,"journal":{"name":"Perspectives in Biology and Medicine","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2022-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48598976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
ABSTRACT:This essay discusses how Susan Shapiro’s Speaking for the Dying (2019) contributes to understanding surrogate decision-making in intensive care. Shapiro’s ethnography is based on over two years of observing day-to-day decision-making by surrogates and family members who found themselves having to speak for loved ones who were no longer capable of expressing their own wishes for treatment or its termination. After summarizing Shapiro’s specific findings—in particular what made no observable difference in decision-making, including advance directives—greater attention is given to how she acts as a witness to the emotional burden and distress that these decisions cause for both family members and professional staff. Shapiro allows us to hear the voices of people forced to make high-stakes decisions in the most stressful conditions with little guidance. We hear the contradictions inherent in surrogate decision-making and gain insight into how the institutional organization of intensive care produces moral distress.
{"title":"Moral Distress in Deciding How Others Die","authors":"A. Frank","doi":"10.1353/pbm.2022.0003","DOIUrl":"https://doi.org/10.1353/pbm.2022.0003","url":null,"abstract":"ABSTRACT:This essay discusses how Susan Shapiro’s Speaking for the Dying (2019) contributes to understanding surrogate decision-making in intensive care. Shapiro’s ethnography is based on over two years of observing day-to-day decision-making by surrogates and family members who found themselves having to speak for loved ones who were no longer capable of expressing their own wishes for treatment or its termination. After summarizing Shapiro’s specific findings—in particular what made no observable difference in decision-making, including advance directives—greater attention is given to how she acts as a witness to the emotional burden and distress that these decisions cause for both family members and professional staff. Shapiro allows us to hear the voices of people forced to make high-stakes decisions in the most stressful conditions with little guidance. We hear the contradictions inherent in surrogate decision-making and gain insight into how the institutional organization of intensive care produces moral distress.","PeriodicalId":54627,"journal":{"name":"Perspectives in Biology and Medicine","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2022-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46968631","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
ABSTRACT:Preventing and reducing loneliness is crucial to well-being and good health. While long thought to be a problem specific to the elderly or infirm, over the past decade the prevalence of loneliness across age cohorts has become increasingly apparent, and calls for a systematic public health approach to the problem have grown louder. This essay uses Vivek Murthy’s Together: The Healing Power of Human Connection in a Sometimes Lonely World (2020) as a point of departure to explore the value of human connection in general—and friendship in particular—as a means to both abating the pernicious individual and societal impact of loneliness and building a foundation for a renewal of the common good. Friendship as a form of human connection is then applied to understanding and addressing the overlapping mental health challenges of American college students and resettled refugee youth.
{"title":"Belonging Together: Friendship, Hope, and Well-Being Among Young Adults","authors":"Suzanne Shanahan","doi":"10.1353/pbm.2022.0009","DOIUrl":"https://doi.org/10.1353/pbm.2022.0009","url":null,"abstract":"ABSTRACT:Preventing and reducing loneliness is crucial to well-being and good health. While long thought to be a problem specific to the elderly or infirm, over the past decade the prevalence of loneliness across age cohorts has become increasingly apparent, and calls for a systematic public health approach to the problem have grown louder. This essay uses Vivek Murthy’s Together: The Healing Power of Human Connection in a Sometimes Lonely World (2020) as a point of departure to explore the value of human connection in general—and friendship in particular—as a means to both abating the pernicious individual and societal impact of loneliness and building a foundation for a renewal of the common good. Friendship as a form of human connection is then applied to understanding and addressing the overlapping mental health challenges of American college students and resettled refugee youth.","PeriodicalId":54627,"journal":{"name":"Perspectives in Biology and Medicine","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2022-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48615029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
ABSTRACT:Phase 1 drug trials—first-in-human tests of new pharmaceuticals— are necessary for FDA approval, and healthy volunteers are necessary to conduct those trials. Bioethicists are rightly concerned with the morally problematic aspects of these trials: Are risks and benefits balanced? Are would-be volunteers sufficiently informed, and have they given proper consent? But these are not the only, or even the most worrisome, ethical problems with Phase 1 research. In Adverse Events (2020), Jill Fisher looks beyond these ordinary bioethical concerns to the moral complications associated with the motivations of healthy volunteers and the demands of the everyday work of running those trials. Her work is the latest example of a much needed “second bioethics.” Unlike the “first bioethics,” this approach views health-care institutions from the outside, examining the structural and organizational sources that generate the ethical quandaries bioethicists are called upon to mediate and the ethical problems they often fail to see. Adverse Events makes clear that the moral problems of medicine can only be addressed by supporting bioethics of both types—the first and the second.
{"title":"A Tale of Two Bioethics","authors":"R. D. de Vries","doi":"10.1353/pbm.2022.0008","DOIUrl":"https://doi.org/10.1353/pbm.2022.0008","url":null,"abstract":"ABSTRACT:Phase 1 drug trials—first-in-human tests of new pharmaceuticals— are necessary for FDA approval, and healthy volunteers are necessary to conduct those trials. Bioethicists are rightly concerned with the morally problematic aspects of these trials: Are risks and benefits balanced? Are would-be volunteers sufficiently informed, and have they given proper consent? But these are not the only, or even the most worrisome, ethical problems with Phase 1 research. In Adverse Events (2020), Jill Fisher looks beyond these ordinary bioethical concerns to the moral complications associated with the motivations of healthy volunteers and the demands of the everyday work of running those trials. Her work is the latest example of a much needed “second bioethics.” Unlike the “first bioethics,” this approach views health-care institutions from the outside, examining the structural and organizational sources that generate the ethical quandaries bioethicists are called upon to mediate and the ethical problems they often fail to see. Adverse Events makes clear that the moral problems of medicine can only be addressed by supporting bioethics of both types—the first and the second.","PeriodicalId":54627,"journal":{"name":"Perspectives in Biology and Medicine","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2022-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46281041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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